异体输血对结直肠癌患者预后影响的meta分析

Effect of allogeneic blood transfusion on clinical outcomes of patients undergoing colorectal cancer surgery:a meta-analysis

目的评估异体输血（allogeneic blood transfusion,ABT）对行手术治疗的结直肠癌（colorectal cancer,CRC）患者远期预后的影响。方法计算机检索PubMed、EMbase、The Cochrane Library以及中国生物医学文献数据库中ABT与CRC患者预后的相关研究,并辅以文献追溯法查找相关文献。检索时限均从建库至2014年3月。由2名评价者按纳入与排除标准独立选择文献、提取资料并评价质量后,采用Stata 12.0软件进行meta分析。结果最终纳入8个研究,共5 479例患者。Meta分析结果显示：与未输血组相比,输血组总生存风险和疾病特异性生存风险分别增加了21%（HR=1.21,95%CI：1.09-1.33,P〈0.001）和47%（HR=1.47,95%CI：1.17-1.84,P=0.001）,差异有统计学意义;而输血组无病生存风险、局部复发风险和远处转移风险与未输血组的差异无统计学意义。结论 ABT可以增加CRC手术患者的总生存风险与疾病特异性生存风险,因此积极采取围手术期血液保护策略以降低ABT率具有重要的临床意义。

Objective To evaluate the effects of allogeneic blood transfusion（ABT）on long-term prognosis in colorectal cancer（CRC）patients undergoing surgery.Methods PubMed,EMbase,The Cochrane Library and China Biology Medicine disc（CBMdisc）were searched for studies on the correlation between ABT and clinical outcomes of colorectal cancer patients,and relevant articles were also retrieved from references.All the searches were done from inception to March,2014.Two reviewers independently screened the literature,extracted the data and evaluated the quality of the data.Then the meta-analysis was performed by using Stata12.0software.Results Finally 8studies involving 5 479 patients were included.The results of metaanalysis showed that,compared with non-transfusion group,the transfusion group had significantly increased risks of overall survival（by 21%,HR=1.21;95% CI：1.09-1.33;P〈0.001）and disease-specific survival（by 47%,HR=1.47;95% CI：1.17-1.84;P=0.001）;whereas the risks of disease free survival,local recurrence or distant metastasis were not significantly different between the 2groups.Conclusion ABT can increase the risks of overall survival and disease-specific survival in CRC patients undergoing surgery;therefore,it is of great clinical significance to take active perioperative blood conservation strategies to decrease ABT rate.